NPIMap

Organization Active NPI

Eilis Clark MD, LLC

  • Psychiatry Physician
  • Lecanto, FL
National Provider Identifier
1336635309
Registry record updated Jan 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
ME80041 Issued in FL
Legal business name
EILIS CLARK MD, LLC
Practice address
210 S Salisbury Ter
Lecanto, FL 34461-5104
Phone
(352) 631-7460
Fax
(352) 600-0549
NPI assigned
Jul 2, 2018
Last updated
Jan 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Eilis Clark, MDNPI 1073621215
Title
MGRM
Phone
(352) 631-7460

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X ME80041 FL Primary

Addresses

Primary practice location

210 S Salisbury Ter
Lecanto, FL 34461-5104

Mailing address

210 S Salisbury Ter
Lecanto, FL 34461-5104
Phone (352) 631-7460

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578700800000",
    "number": "1336635309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 S SALISBURY TER",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344615104",
            "telephone_number": "352-631-7460",
            "fax_number": "352-600-0549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S SALISBURY TER",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344615104",
            "telephone_number": "352-631-7460",
            "fax_number": "352-600-0549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EILIS CLARK MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-02",
        "last_updated": "2020-01-11",
        "certification_date": "2020-01-11",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "EILIS",
        "authorized_official_title_or_position": "MGRM",
        "authorized_official_telephone_number": "352-631-7460",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME80041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lecanto, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.